Favorite Schools

Favorite Teams

Outbreaks of measles and mumps in Ohio have put the state at the center of a surge in vaccine-preventable illnesses this year. Ohio, which now has 83 cases of measles, has more measles cases than any other state outbreak since 1996.
(File photo)

Have the recent measles and mumps outbreaks changed your views on vaccination? Share your thoughts in the comments below.

CLEVELAND, Ohio— An outbreak of measles in the Amish community in central Ohio, which has now infected 83 people, has thrust the state into the national spotlight in a most unwelcome way: we are now host to the largest measles outbreak in the country since 1996.

Add to that an ongoing mumps outbreak around Ohio State University that has infected more than 350 people, and you may begin to wonder if diseases like these, which are vaccine-preventable and no longer considered a major threat in this country, are winning the fight to make a comeback.

Measles and mumps are highly contagious viral illnesses, transmitted via saliva by cough or sneeze, or through shared objects such as cups and utensils. Mumps typically starts with a few days of fever, headache, muscle aches, tiredness, and loss of appetite, and is followed by swelling of salivary glands. Measles (also called rubeola) causes fever, runny nose, cough and a distinctive rash all over the body.

While most people who contract mumps or measles will recover on their own, some do not fare as well. About one out of 1,000 children with measles gets encephalitis, and one or two out of 1,000 die, according to the Centers for Disease Control and Prevention. Mumps can also cause serious complications, including encephalitis and meningitis.

The central Ohio measles outbreak began in late March when two members of the Amish community in Knox County returned from the Philippines with a missionary aid group helping victims of Super Typhoon Haiyan. The Philippines is in the midst of a large, ongoing measles outbreak with more than 26,000 cases reported this year, according to the CDC.

When they fell ill, they were initially misdiagnosed with dengue fever, a mosquito-borne illness, health officials said. When others in their families became sick, it was clear the disease wasn't dengue.

"That was sort of a hiccup in the case because we didn't get a chance to jump on it right away," said Pam Palm, spokeswoman for the Knox County health department. The delay in a proper diagnosis likely added to the number of people infected, she said. "They didn't realize that what they had was contagious."

Everyone who has been infected with measles was unvaccinated, Palm said, which is common in the Amish community. The people who traveled to the Philippines did get tetanus shots before their trip at the department of health, and said they would have been vaccinated for measles before going if they'd known the disease was endemic there.

"Nobody said 'where are you going and did you know there's a measles outbreak'," Palm said.

An outbreak of measles in California, also linked to the Philippines, has infected 59 people this year as of May 16, the highest in that period since 1995. More than 70 percent of the 59 patients were either unvaccinated or didn't have vaccine documentation available. Nineteen of the 25 who were known to be unvaccinated had chosen to forgo the shots due to philosophical objections.

Ohio's and California's outbreaks are part of a troubling national picture: As of May 9, there were 187 measles cases in 15 outbreaks reported in 17 states. Since the disease's official elimination in the U.S. in 2000, the highest number of annual cases of measles was 220 in 2011, according to the CDC.

Mumps spreads despite vaccination in close quarters

While unvaccinated travelers and communities with high numbers of vaccine refusers are providing the perfect breeding ground for measles, mumps can spread even among those who are vaccinated, given the right conditions.

The right conditions for the spread of mumps: close quarters, and contact with a lot of other people. In a word: college.

The ongoing outbreak at Ohio State University is one of two on college campuses this year. The second, which involved 13 people at Fordham University in New York, was reported in February.

The two most recent large outbreaks were also spread within schools and similar communities. In 2006, there was an outbreak centered on college campuses in the Midwest that affected more than 6,000 people across the country, and in 2009, an outbreak of more than 2,500 cases started in close-knit religious communities and schools in the Northeast.

Despite these outbreaks, the disease is still exceedingly rare. Before vaccination began in 1967, there were about 186,000 cases of the disease a year in the U.S. Vaccination has cut down on the disease by about 99 percent, but it's not foolproof: two doses of the MMR (measles, mumps rubella) vaccine are about 88 percent effective against infection with mumps, while one dose is about 78 percent effective. Compare that to a 99 percent effectiveness against measles.

"The situations are a little different," said ODH state epidemiologist Mary DiOrio. "Mumps is more of a reflection of a vaccine that's not perfect. Even among people who have been vaccinated, with a lot of virus circulating, it's going to find those individuals for whom the vaccine didn't provide complete protection."

Having a high vaccination rate in the population helps cut down on the number of people who are infected when the virus enters a college campus, DiOrio said, and ODH has been encouraging students and community members to check their vaccination status and get up to date if necessary.

It's also difficult with mumps to figure out where the disease originated, because many people show no symptoms when they're infected.

"In a certain area we can know who's going to be at high risk because of close contact, but it's not something where we can pin it to a starting point," she said. "With measles, on the other hand, people develop a pretty pronounced illness so we can usually pinpoint where it started."

Vaccination, education best tools

Public health officials are pushing vaccination throughout the state, especially as summer approaches and children prepare to head off to camps.

In the Amish community around Knox County, the health department is holding free vaccination clinics and many are getting the shots they need, Palm said. The health department still expects four or five more weeks of new cases before the outbreak may quiet down.

"This big influx we had this past week was probably because of Easter weekend, because people were contagious and getting infected then," she said. Measles takes about three weeks to show symptoms from the time of infection.

ODH does not recommend a third shot if you've already had your two doses of MMR vaccine. If you're unsure if you've had the vaccinations, there is a blood test that can tell you if you're immune to the diseases.

"It's also fine to get another shot if you don't know," DiOrio said. "That's probably the easiest thing to do."

DiOrio hopes that this outbreak has helped bring attention to infectious diseases such as measles that are disturbingly common abroad in places travelers may not expect.

"Internationally there are a lot of infectious diseases that we don't typically see in the United States that people should be aware of and take appropriate protection," she said. "Our guidance for any international travel is that people should look at getting measles vaccination, because it's not just the Philippines."

If you're looking for information about international travel, you can go to the CDC's Traveler's Health website here, or the World Health Organization's site here, or call your local public health department.

Clues to Cancer: Patients, doctors on road to discovery

For 10 months, Plain Dealer reporter Angela Townsend and photographer Lynn Ischay followed 9 patients through their journey as study participants in Phase 1 trials at University Hospitals. We tell their stories here.

Follow Us

cleveland.com is powered by Plain Dealer Publishing Co. and Northeast Ohio Media Group. All rights reserved (About Us).The material on this site may not be reproduced, distributed, transmitted, cached or otherwise used, except with the prior written permission of Northeast Ohio Media Group LLC.